Ascites surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]


Surgery is the mainstay of treatment for refractory ascites. Refractory ascites is defined as ascites that can not be mobilized or the early recurrence of which can not be satisfactorily prevented by medical therapy. Large volume paracentesis is the choice treatment for patients with tense ascites. Transjugular intrahepatic portosystemic shunt (TIPS) would be indicated when there is frequent (> 3 times per month) need for large volume paracentesis to manage ascites. Liver transplantation is indicated for refractory ascites treatment in patients that can not be underwent TIPS.


Refractory Ascites
Large volume paracentesis
Salt restriction and diuretics
Not controlled
Salt restriction and diuretics
TIPS possible
TIPS not possible
Repeated Large volume paracentesis
Liver transplant

Large volume paracentesis

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Liver transplantation


  1. Moore KP, Wong F, Gines P, Bernardi M, Ochs A, Salerno F, Angeli P, Porayko M, Moreau R, Garcia-Tsao G, Jimenez W, Planas R, Arroyo V (2003). "The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club". Hepatology. 38 (1): 258–66. doi:10.1053/jhep.2003.50315.
  2. Krag A, Madsen BS (2015). "To block, or not to block in advanced cirrhosis and ascites: that is the question". Gut. 64 (7): 1015–7. doi:10.1136/gutjnl-2014-308424. PMID 25398769.
  3. 3.0 3.1 Biecker E (2011). "Diagnosis and therapy of ascites in liver cirrhosis". World J Gastroenterol. 17 (10): 1237–48. doi:10.3748/wjg.v17.i10.1237. PMC 3068258. PMID 21455322.
  4. Pache I, Bilodeau M (2005). "Severe haemorrhage following abdominal paracentesis for ascites in patients with liver disease". Aliment. Pharmacol. Ther. 21 (5): 525–9. doi:10.1111/j.1365-2036.2005.02387.x. PMID 15740535.
  5. Ginès P, Titó L, Arroyo V, Planas R, Panés J, Viver J, Torres M, Humbert P, Rimola A, Llach J (1988). "Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis". Gastroenterology. 94 (6): 1493–502. PMID 3360270.
  6. Peltekian KM, Wong F, Liu PP, Logan AG, Sherman M, Blendis LM (1997). "Cardiovascular, renal, and neurohumoral responses to single large-volume paracentesis in patients with cirrhosis and diuretic-resistant ascites". Am. J. Gastroenterol. 92 (3): 394–9. PMID 9068457.
  7. Rössle M, Siegerstetter V, Huber M, Ochs A (1998). "The first decade of the transjugular intrahepatic portosystemic shunt (TIPS): state of the art". Liver. 18 (2): 73–89. PMID 9588766.
  8. Saab S, Nieto JM, Lewis SK, Runyon BA (2006). "TIPS versus paracentesis for cirrhotic patients with refractory ascites". Cochrane database of systematic reviews (Online) (4): CD004889. doi:10.1002/14651858.CD004889.pub2. PMID 17054221.

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